Hoop Jumping 101

Last week I got my C.C.C.S.R. (Corporate Chart Compliance Score Report) and passed with flying colors. I thought y’all might enjoy the background on this aspect of medical practice.

If you want to be a modern Doc, you’ve gotta get real good at hoop jumping. I can’t speak to the realities of other professions with authority, but my guess is the same is true for other lines of work such as a teacher or minister. I have a saying I came up with. “If you want to do some good in the world, be prepared for a hard time and hurdles to jump to make it happen. If you want to do bad, you can count on adequate latitude and tolerance, and significant empathy.” So be it for hoop jumping 101.

Like all modern health care delivery systems, we have Corporate Compliance Officers. For all my teasing, they do a great job. They don’t know anything about being a Doc, but they are master chart coders, and can tell you within a .01% tolerance range whether or not your charts would hold up to the scrutiny of the meanest of the mean government inspectors. Mine always pass, in fact I usually grade out at 100%. Here’s how.

First of all, I’ll tell you as far as a bubble test, (standardized computer scored test- another story there) I was always an ace. Maybe not as good as old Brilliancy, but good. And I could spot urosepsis at fifty paces with uncanny accuracy. As far as caring, I did. I went to bed many a night worried over someone’s microcytic indicies on their blood count, and how I might convince them a colonsoscopy was in their best interest.

Also, I knew my patients well. Whenever we had a young nurse fill in, the old hands would tell her to ask me about a patient, and not let me have the benefit of a chart to refer to. I would start out, “Oh yeah, well, ten years ago, back in the old ER….” They soon learned not to ask unless they really wanted to know.

None of this personal data base is of any concern to the government or insurance chart jockeys, though. They want to know what is on the piece of paper, and nothing else matters. (By contrast, I want to know the patient and nothing else matters.)

Whenever we went through corporate acquisition, I knew formal Corporate Compliance would be part of the package, and believe it or not this old bluegrass boy welcomed the help. Taking good care of my people in no way qualifies to navigate the mysteries of the burecratic maze that must be unraveled to satisfy all the regulations, so I welcomed our new C.C. Officer with open arms. She was surprised, to say the least. Here is how it went.

The first day I laid eyes on the woman, I had my doubts. I figured she was a regular General Patton. I wasn’t gonna be surprised if she was packing pearl handled pistols. However, it was my best interest to put aside any preconceived notions. Even if this turned out to be the enemy, it would be an enemy I needed to hold close. “Hey, I’m Dr. Bibey. Nice to meet ya.” I stuck out my hand to shake and howdy.

She placed a briefcase and a thick sheaf of papers on the table, and shook my hand.

“Ma’am, before you start I want to tell you my philosophy and how you can help me.”

“Certainly, Dr. Bibey.” She seemed wary. Generally speaking, Docs hate supervision or anyone telling them what to do, and many view the C.C. officer as just a shade above a Gestapo. (Organizing Docs is like herding stray cats.) We sat down at the table.

“Ma’am, I’ve kept up with medicine to the best of my ability, and I do good by my patients. However, I’ve been through three dictation formats, and none of them satisfy both my desire to communicate with other professionals about my patients and meet Government guidelines. I can keep up with the patients easy enough, but the format I use that meets Government criteria is so unwieldy no one can sort through it and make any sense about what was going on with my patients. You gotta help me find some middle ground that will satisfy both needs. I am beyond frustrated with it.”

“Dr. Bibey, I am confident we can do that.”

“Well good. What I want you do is beat me like the worst yard dog you ever thought of. I want to to get out a rubber hose and just whale away till I can’t take no more punishment. I want you to plum torture me.”

“You do?” I don’t think she’ d had this request before.

“Yes Ma’am. Let me tell you a story.” (I tend to talk in parables.) “My best mando buddy is a guy named Darrell. When I first met him, I realized he was a very gifted musician- way beyond this old boy.” I know she wondered what this had to do with medical charts. “I told him I wanted him to be honest with me. Any time he saw something in my playing, or singing, that needed some work I wanted him to point it out. I made it clear he could not hurt my feelings or ego. I knew he could help me from the get-go, and I hoped I could help him in some way, too. I figure it’s the same way in this deal. You know all about the regulations, and I am lost in ’em. I’ll promise you the same thing I promised Darrell- you can’t hurt my feelings.”

“Dr. Bibey this is most unusual. Usually the Docs hate me.”

“Kid, they don’t hate you. They hate the process. It’s just displaced anger. I don’t see any point in shooting the messenger.”

She laughed. “O.K. Dr. Bibey. But it might be harder than learning how to sing.”

“You don’t know how bad a singer I was when Darrell got a hold of me.”

Well for the next months this woman came in and turned every chart of mine inside out. She came up with every possible suggestion to drag me kicking and screaming into the modern world of bureaucracy.

As you might guess, I emerged on the other side better off for the process. I never miss on a chart review. Like a man with an ethical and smart tax adviser, I have no fear of the I.R.S., and I don’t run scared of an unknown bureaucrat either.

And as it turned out ole Patton wasn’t a pistol packing mama anyway, and became a bluegrass fan who comes to my shows. I’m sure she believes Darrell should have been a bit harder on me about my singing, but she forgives me. If I was a better singer someone might ask me to hit the road, and I’m the only Doc she’s ever had who demanded she kick his @^^. I’m one less thing to worry about for her, and she has plenty.

If I weren’t happily married, and if it weren’t against Corporate Harassment policy, I’d hug the kid’s neck. She’s a good’un. On my last review I made 90. I missed one ’cause I recorded the fact I got the wax out of a patients ear but didn’t say how I did it, or dictate what instrument I used. Given I always use my favorite old cerumen spoon with the bend in it, it wasn’t hard for to tack on an addendum (and date for the day of the addition.) Why in the world anyone in Washington would care is beyond me, but whatever. I’ve learned what I have to do to satisfy all the regulators and keep practicing medicine. Just to be clear though, none of it has a thing to do with taking care of patients. It is something we get out of the way so we can continue doing what we love. The two are unrelated.

But, I have always been a good student. Under the tutelage of the master coder this bureaucratically disinterested bluegrass boy can ace Hoop Jumping 101 on a regular basis.

This ear wax gig is a non-problem. From here on out, without fail, I’m gonna dictate I used my O.G.A.C.C.C.S. (official government approved corporate compliant cerumen spoon- my favorite one with the bend on the end) to dig out ear wax. And this will go on till the G.O.E.M.A. (Government Office for the Eradication of Medical Abbreviations) catches up with me. Then I’ll just have to dream up some other creative way to worry them.

So, Ms. Patton, this post is in honor of you. Go kick some b#^^ and next time you eat lunch with one of them regulator folks, tell ’em to come out and hear some good music. They need a hobby!

I started to read your missive, and started to find all the things wrong with it — I am just that way. My dad told me that we are all human, and it is the job of the boss to figure out what others are doing wrong, and get it corrected. Well that is a damn habit I have. Problem is with you, even as you use big words they are musical, enjoyable and fun to hear in my mind. Keep them coming. I don’t care if I missed the first five minutes of the Kansas/Memphis game. I didn’t even know it was on. That, my dear Dr.B, tells something of the story telling.
I don’t know how you did it, but I can draw the scene when you sat down at the table with her and told her to not let you get away with anything on those charts. Beautiful — If you could only play music like you can write.